<form action="/admin/customer/invoice-custom-save" id="plate-add-form" data-toggle="ajaxform" data-options="{closeCurrent:true}">
    <div class="bjui-row">
        <input type="hidden" name="customer_id" value="{{$customerId}}">
        <div class="bjui-row col-2">
            <label class="row-label">名称</label>
            <div class="row-input required">
                <input type="text" name="account_name" id="account_name" data-rule="required">
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">电话</label>
            <div class="row-input required">
                <input type="text" name="telphone" id="telphone" data-rule="required">
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">纳税人识别号</label>
            <div class="row-input required">
                <input type="text" name="taxpayer_number" id="taxpayer_number" data-rule="required">
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">开户行</label>
            <div class="row-input required">
                <input type="text" name="opening_bank" id="opening_bank" data-rule="required">
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">账号</label>
            <div class="row-input required">
                <input type="text" name="bank_card_number" id="bank_card_number" data-rule="required">
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">省市区</label>
            <div class="row-input">
                <select name="province_id" id="province_id" data-nextselect="#city_id" data-toggle="selectpicker" data-refurl="admin/address/ajaxAreaList?type=2&value={value}">
                    <option value="">请选择</option>
                    @foreach ($provinceList as $val)
                        <option value="{{$val['provinceID']}}">{{$val['province']}}</option>
                    @endforeach
                </select>
                <select name="city_id" id="city_id" data-nextselect="#area_id" data-toggle="selectpicker" data-refurl="admin/address/ajaxAreaList?type=3&value={value}">
                    <option value="">请选择</option>
                </select>
                <select name="area_id" id="area_id">
                    <option value="">请选择</option>
                </select>
            </div>
        </div>
        <div class="bjui-row col-2">
            <label class="row-label">详细地址</label>
            <div class="row-input">
                <input type="text" name="address" id="address">
            </div>
        </div>
        <div class="bjui-row col-2">
            <div class="row-input">
                <label class="row-label"></label>
                <button type="submit" class="btn-default" data-icon="save">保存</button>
                <button type="button" class="btn-close" data-icon="close">取消</button>
            </div>
        </div>
    </div>
</form>
